Download schedule 2 – the services

SCHEDULE 2 – THE SERVICES
A.
Service Specifications
Mandatory headings 1 – 4: mandatory but detail for local determination and agreement
Optional headings 5-7: optional to use, detail for local determination and agreement.
All subheadings for local determination and agreement
Service Specification No.
Service
Community Adult Audiology / Hearing Aid Services
Commissioner Lead
Cheryl Harding-Trestrail
Provider Lead
TBC - Locally Qualified Provider
Period
1st April 2017 - 1st April 2020
Date of Review
1st April 2018 and annually thereafter
1.
Population Needs
1.1
National/local context and evidence base
The impact of hearing loss in adults can be great both at a personal and a societal level
leading to social isolation, depression, loss of independence and employment challenges.
Assessing the hearing needs of patients with hearing loss, developing an individual
management plan and providing appropriate interventions can reduce isolation, facilitate
continued integration with society and promote independent living.
One in six people in the UK have some form of hearing loss. Most are older people who are
gradually losing their hearing as part of the ageing process, with more than 70% of over 70
year-olds and 40% of over 50 year-olds having some form of hearing loss
(http://www.actiononhearingloss.org.uk/)
Around 2 million people in the UK currently have a hearing aid, however, approx. 30% of
these do not use them regularly, and there are a further 4 million people who do not have
hearing aids and would benefit from them.
In addition nationally we are faced with an ageing population, where there will be an
estimated 14.5 million people with hearing loss by 2031. The World Health Organisation
predicts that by 2030 adult onset hearing loss will be a long term condition ranking in the top
ten disease burdens in the UK, on a par or perhaps exceeding those of diabetes and
cataracts.
West Hampshire Clinical Commissioning Group (WH CCG) serves a population of over
550,000 people, in a geographical area of 2,242.4 square kms (865.8 square miles).
There are 51 GP practices within the area, each being a core member of six localities, within
three local health systems, to keep a local focus:
North System
South System
West System

Winchester and Rural
(WINCAR) Locality

Eastleigh North and Test
Valley South Locality

Totton and Waterside
Locality

Andover Locality

Eastleigh Southern
Parishes Locality

West New Forest Locality
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The West Hampshire (WH) population is older than the England population with a smaller
proportion of younger people and working age people. This pattern is very marked across
the West New Forest practice grouping.
The ageing population means that demand for both hearing assessment and treatment
services is set to rise substantially over the coming years. However, a significant proportion
of this client group will have routine problems that do not require referral for an Ear, Nose
and Throat (ENT) or specialist audiology out-patient appointment prior to assessment.
WH CCG wants to secure high quality assured services which ensure equality of access to
services across the local area, which offers best value for money, is sustainable and
affordable.
For the purposes of this specification, adult onset hearing loss is measured by a
professional during a comprehensive hearing evaluation. During a comprehensive hearing
evaluation, the ability to hear speech and frequency-specific tones as a function of the
loudness required to hear them is assessed as well as functional disability.
Hearing is measured as “loudness versus pitch” and results are plotted on an audiogram.
Hearing loss (HL) is measured in decibels (dB) and is described in general categories:
Degree of Hearing loss Audiometric Thresholds (objective measure):
•
Normal hearing (0 to 25 dB HL) – NHS funded devices not routinely supplied
•
Mild hearing loss (26 to 40 dB HL) – NHS funded devices may be supplied*
•
Moderate hearing loss (41 to 70 dB HL) – NHS funded devices should be supplied
•
Severe hearing loss (71 to 90 dB HL) – NHS funded devices should be supplied
•
Profound hearing loss (greater than 91 dB HL) – NHS funded devices should be
supplied
The degree of function disability, using a validated (subjective) measurement tool, such as
GHABP Score, should also be assessed to determine level of correction need.
* NB – where the individual has mild hearing loss bilaterally and a moderate functional
impairment or occupational requirement, NHS funded devices should be offered. See
appendix 7.
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2.
Outcomes
2.1
NHS Outcomes Framework Domains & Indicators
Domain 1
Preventing people from dying prematurely
Domain 2
Enhancing quality of life for people with long-term conditions
X
Domain 3
Helping people to recover from episodes of ill-health or
following injury
X
Domain 4
Ensuring people have a positive experience of care
X
Domain 5
Treating and caring for people in safe environment and
protecting them from avoidable harm
X
2.2
Local defined outcomes

Patients will perceive benefit from being fitted with a hearing device and be
continuing to wear it 12 months after fitting.

Meets the principle of convenient care closer to home by ‘Assess and fit’. Providers
will demonstrate that a majority of hearing aids fitted are assessed and fitted at first
booked appointment.

Patient triggered follow-up is standard practice.

Patients can trigger a review appointment for ‘trouble-shooting’ and minor
repairs/adjustments within 3 working days and can access any branch/franchise of
the provider.

The service must be available through the NHS Electronic Referral System (ERS)
and should be directly bookable to ensure a seamless patient journey.

Demonstrable integration of pathways with local Community ENT Service providers.

Providing high quality care and taxpayer value for money.
Key Service Outcomes – performance indicators
2.3

90% of patients referred to the service should be assessed within 16 calendar days
of receipt of referral

90% of patient requiring hearing aid fitting should be seen within 20 working days of
the assessment

90% of fitting follow-up appointments should be within 90 days of the fitting

98% of patients should be able to access aftercare within three (3) days of request

98% of patients will perceive benefit from being fitted with a hearing device
measured through before and after fitting GHABP Scores.

90% of responses received from a representative patient sample via a service user
survey should report overall satisfaction with the service as good/very good or
excellent - By Local Venue/Branch

90% of responses received from referrers to survey should report overall
satisfaction with the service as good/very good or excellent - By Local
Venue/Branch
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3.
Scope
3.1
Aims and objectives of service
To deliver a high quality, local audiology service for adult patients that conforms to The
British Academy of Audiology Guidelines (2015)1.
The ‘Action Plan on Hearing Loss’ (DH, 2015), ‘Improving Access to Audiology Services in
England’ and the good practice guidance ‘Transforming Adult Hearing Services for Patients
with Hearing Difficulty’ (DH, 2007) should also be taken into consideration in delivering the
service model.
Patients will receive high quality efficient services, with short waiting times (within 6 weeks)
and high degree of responsiveness to patient need. The key principles of the service are:

Compliance with established clinical guidelines and good practice, principally the
British Academy of Audiology (BAA);

Diagnosis and management of hearing loss through improved patient and local
professional education;

Provide person-centred care and devices tailored to patient clinical need;

Respond to psychosocial and communication needs by providing timely signposting
to lip reading classes and other rehabilitation services;

Promote inclusion and participation of people who are deaf or hard or hearing;

Ensure that NHS service standards are maintained and resources are used
economically and wisely for the benefit of the local population.
Expected outcomes of the service:

Timely access to hearing assessment, necessary device fitting and patient triggered
follow up.

Collaboration with partner organisations to ensure that waiting times associate with
the service and pathway of care are in line within 18 week referral-to-treatment
targets (RTT) waiting time standards where patients need onward referral to ENT.
This means that the provider must ensure any onward referral in made within 3 days
of clinical assessment.

Maintaining waiting times to a maximum 6 weeks for diagnosis (assessment) as set
out in the Department of Health document Transforming Adult Hearing Services for
patients with hearing Difficulty – A Good Practice Guide and in line with best
practice guidance of British Academy of Audiology.

Personalised care for all patients accessing the service, including education and
support to enable appropriate hearing rehabilitation. This means getting it right and
solving problems for the patient.

High levels of satisfaction from referrers to the service.

Improved quality of life for patients measured through high levels of satisfaction
from patients accessing the service
3.2
Service description/care pathway
3.2.1
Referral
The Service will accept referrals direct from Primary Care and from West Hampshire
1
ww.baaudiology.org/files/1714/3029/2743/BAA_Guidance_on_Identifying_Cases_of_Non_Routine_Hearing_Loss_in_Adults_April_2015.pdf
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Community ENT Service through the ERS as the default; other methods of referral should
be accepted but not actively promoted.
Referrals should be expected to detail any screening assessment completed by primary
care and / or the community ENT service including, where available, results of ‘hearcheck’,
practice based screening.
The Service will make appointment slots directly bookable through ERS to support patient
choice and to improve accessibility of the service.
3.2.2
See and fit
Wherever possible a ‘see and fit’ appointment should be offered, this will improve the
patient journey and reduce the number of appointments required. At this appointment the
requirements within 3.2.4 and 3.2.5 must be completed.
3.2.3
Clinical Environment
Clinical assessments shall be conducted in an appropriately sound treated room where
ambient noise levels are compliant with the ‘BS EN ISO 8253-1:1998 standard, AcousticsAudiometric Test Methods – Part 1: basic pure tone air and bone conduction threshold
audiometry’. If this is not possible because the assessment is being carried out in the
patient’s own residence, or satellite community premises, then the 35dBA Standard should
be achieved before testing. This should be done in situ with a portable sound level meter
and the evidence of recording documented and be available to commissioner inspection if
requested.
3.2.4
Personnel
The Provider should have an appropriate skill mix with the local team in keeping with the
recommendations set out in ‘Transforming Adult Hearing Services for Patients with Hearing
Difficulty’ (DH, 2007).
The provider must ensure that clinical staff are appropriately trained and experienced to
assess, diagnose and treat patients with routine and non-standard presentations of hearing
loss.
Assessments and hearing aids should always be provided and dispensed by appropriately
qualified and experienced personnel who are registered with an accredited national body –
see Appendix 1.
Hearing technicians (or other unqualified staff) should be appropriately trained and have
regular clinical supervision, to offer cleaning, minor repairs and maintenance support
independently.
3.2.5
Assessment
Assessment should be undertaken within 16 working days of receipt of referral (unless the
patient requests this to be outside of this time e.g. holiday, sickness etc.).
The Provider should ensure patients have an adequate understanding of the hearing
assessment process before the appointment, by providing information (in a suitable
language and format) in advance (either via the referrer or to be received by the patient at
least 2 working days before the appointment) that explains the purpose of the assessment,
what it involves and the possible outcomes.
Providers should make patients aware of their right to communication support, and how to
request this if required.
It should be understood that the landscape of the NHS is changing, to include independent
NHS service providers and patients may need explanation and support to understand
changes in provision.
In addition, Providers should provide details of which professional (job title and name where
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possible) will perform the test as well as a choice of when and where it will take place. To
help with identification, a notice board with key staff pictures is desirable in clinical
premises.
Patients should be encouraged to bring a relative significant other or carer to the
appointment for support if they wish.
The Service will undertake a complete and comprehensive audiology assessment and
where appropriate complete a ‘see and fit’ process subject to patient choice, ensuring that
the patient receives their aid /or treatment and any supporting education at that
appointment.
The first appointment should seek to elicit the patients’ medical/social history and
expectations towards her/his hearing, tinnitus and/or balance problems.
The Assessment should consider:
i.
Sensory Impairment
ii.
Activity implications
iii.
Participation restrictions
iv.
Contextual factors
The service should aim to set joint goals with the patient through structuring and evaluating
a rehabilitation and education programme which is individually designed for a particular
client and her/his significant other(s) to ensure best possible outcome for the patient.
The audiology professional should aim to suggest a range of appropriate intervention
options, offer decision support aid and to facilitate informed patient choice. The chosen
management option(s) should address both the auditory and non-auditory needs of the
client.
Counselling and support should be provided so that the management options are effectively
implemented and maintained and non-adherence is reduced. Self-management should be
promoted because this builds self-confidence, self-efficacy and competency in managing
the device technology and/or symptoms and difficulties for good long-term benefit.
A full assessment must cover:

A clinical interview to assess hearing and communication needs - this should
establish relevant symptoms, co-morbidity, hearing needs, auditory ecology,
dexterity, and cognitive ability, significant psycho-social issues, lifestyles (including
driving, use of mobile phones, TV, etc) expectations and motivations

Full otoscopy

Measurements of pure-tone air and bone conduction thresholds - if there are
contra-indications to performing Pure Tone Audiogram (PTA) - for example,
occluding wax, discharging ear, exposure to sustained loud sound in the 24 hours
preceding test - the patient must be informed of the reason for non-completion and
rebooked.

Patients should be offered simple advice and treatment for simple ear wax removal
or referred to the Community ENT service for consideration of treatment as
necessary. Such events should be recorded as ‘Incomplete Assessments’.

Assessment of current activity restrictions and participatory limitations - using
a formal validated self-report instrument - that will enable an outcome measure to be
documented for both the individual patient and also the service. The Glasgow
Hearing Aid Benefit Profile (GHABP) is the preferred outcome measures for this
service (GHABP Information Package), this should be administered during the initial
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assessment before any aid is fitted.

Assessment of eligibility for NHS hearing aid provision, as per the thresholds
set in Appendix X

If at least one aid is fitted, the GHABP should also be administered between 30 and
90 days after fitting. If the patient doesn’t visit the provider, this can be administered
by other means.

The Provider should agree with commissioners an objective, auditable tool used to
measure hearing loss, for quality control.

Assessment of loudness discomfort levels - where required

Integration of assessment findings with patient expectations - to enable
patients to decide on appropriate and suitable interventions/devices (i.e. hearing
aids, communication support, education etc.) – no device is an option and should be
recorded as ‘Assessment only’.

It should be confirmed that the patient understands the benefits of wearing a
device and is committed to achieving the perceived benefits.
Following the assessment, the practitioner should:

Explain the assessment, including the extent, location, configuration and possible
causes of any hearing loss and the impact hearing loss can have on communication
e.g. poorer speech discrimination and sound localisation and the impact this can
have on a personal and societal level.

Discuss with the patient the management options available to address their hearing
loss and whether a hearing aid would be beneficial, exploring the psycho-social
aspects of the hearing loss, as well as the physical aspects (e.g. audibility of sounds
and speech) To facilitate this process the significant other(s) should be encouraged
to attend the decision-making appointment, with the permission of the client.

Work collaboratively with the patient to establish realistic expectations for the
management suggested providing all relevant literature (in a suitable language and
format) to facilitate discussions
3.2.6
Fitting
Where hearing aids are expected to be beneficial, the individual meets the eligibility criteria
and hearing loss is above the eligibility threshold; and the patient wishes to accept
provision of hearing aids:

Develop a written Individual Management Plan (IMP) with the patient which defines
the patients’ goals and hearing needs and how they are going to be addressed

Discuss and document hearing aid options and agree types and models with the
patient based on their suitability to the patients’ hearing loss

Discuss and document whether a unilateral or bilateral fitting is appropriate. Any
decision in this respect must be based on clinical need and not financially driven.
Bilateral fittings are not clinically appropriate where:
o
One ear is not sufficiently impaired to merit amplification or hearing would
not significantly improve through the use of an aid
o
One ear is so impaired that amplification would not be beneficial (and should
be referral back to the GP for onward referral to complex audiology or other
support services)
o
The patient declines bilateral aiding or is not committed to wearing both aids
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where offered as appropriate (this should be confirmed in a signed
statement by the patient)
o
Where patients are assessed as needing bilateral fitting but the patient
requests a trial with one device, the request should be respected,
documented and processed as unilateral fitting. If subsequently the patient
proceeds to bilateral fitting, the appropriate top-up fee should be claimed.
o
Other reason (e.g. manipulative ability, otological)

Proceed to fitting using open ear technology or take impressions and decide on
choice of ear mould type and characteristics

Provide patient information (in a suitable language and format) and ensure that the
patient has understood the major points arising from the assessment including
details of the hearing aid(s) which have been, or will be, fitted and any follow-up
arrangements

Electronically record details of the assessment appointment, including any
comments by the patient.

The patient should be afforded the opportunity to complete a ‘walk around’ where
they can spend some time with their new aid outside the clinic setting to understand
the true effect of the aid in ‘real life’ and to ensure it is set to the correct level.

Otoscopy

A review of the patient information and outcome measures (GHABP)

Selection and programming of hearing aids

Objective measurements (e.g. Real Ear Measurements (REM)) to verify fitting by
agreed protocol (e.g. BAA/BSA recommended procedure) and adjustment of
hearing aid output to match target exceptions to be reported in the Individual
Management Plan

Modification of ear moulds/venting if necessary and repeat of objective
measurements for verification

Evaluation of subjective sound quality (including own voice) and fine tune if
necessary

With patients own aid(s) worn and switched on, teach the patient (using same
model) how to:
o
Change battery – observe insertion and removal and correct processes for
maintaining battery life
o
Operate controls
o
Switch between programmes
o
Insert and remove aids
o
Use loop
o
Take care of aids, including cleaning, re-tubing and what to do if the aid is
damaged or appears not to be working

Advise on acclimatising to the use of hearing aids and amplified sound

Advise on battery warnings, battery supply, repair/maintenance service

Supply cleaning wires if open ear fit

Explain the purpose and function of hearing aid data-logging
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
Advise on lost/damaged hearing aid charging policy

Issue a copy of the audiogram, information (in a suitable format) on the aids, ear
moulds, local services, and update the IMP.

Issue a Hearing Aid Battery booklet

Discuss patient’s wider needs and provide signposting to any relevant support
services (including lip-reading classes and assistive technologies), as agreed with
the patient, in accordance with agreed local protocols

Supply written information to support advice and education offered.
3.2.7
Follow-up / re-assessment
Hearing and/or balance related problems tend to be long-term conditions and their
management may change over time. A review of the effects of treatment should form an
essential part of the rehabilitation process because it considers whether or not the
management option is satisfactory with respect to the goals that were jointly set.
It is anticipated and recognised in the tariff system that the patient, registering with a local
branch (their ‘Home- Branch’ or provider) will be satisfied with care and service from that
branch and will stay registered with them for a minimum of three (3) years. Where the
patient moves or requests a transfer the Provider may offer details of branches within their
franchise or group. In such cases the provider should ensure timely transfer of patient
information.
A telephone contact for patient support, for queries should be offered by the patients
‘home-branch’.
Follow-ups should be offered on a patient initiated basis, offered to all patients without
pressure or prejudice. Follow-ups should continue where appropriate, and especially if the
client is experiencing problems. Patients should be offered the choice of a face to face or
non-face to face follow-up, within any follow-up the provider should:

Discuss with the patient whether the outcomes agreed within the IMP have been
met and if not how to resolve residual needs and update the IMP as necessary

Check on use of hearing aid(s) in terms of comfort, sound quality, adequacy of
loudness, loudness discomfort, noise intrusiveness, telephone use, battery life,
cleaning, use of loop and different programmes

Repeat Glasgow Hearing Aid Benefit Profile (GHABP) between 30 and 90 days after
initial fitting. Result may determine need for update to the IMP as necessary

Confirm patient’s ability to remove and insert aid and provide further help if needed

Review hearing aid data-logging

Fine tune hearing aid (if necessary) based on patient’s comments

Administer the follow-up validated outcome measure (GHABP) plus any additional
measures used to assess the effectiveness of the intervention and respond to result

Conduct objective measurements e.g. REM (if necessary)

Provide information (in a suitable language and format) and sign-posting to any
relevant communication/social/rehabilitation support services
The Provider should:

Update the IMP in conjunction with the patient to ensure that any residual need has
a plan of action
2017-18 Extended Specification V14

3.2.8
Maintain confidential electronic records of the follow-up appointment including
completed copies of the outcome tool, any adjustments made to the aid(s) and
comments made by the patient
Aftercare
The provider should provide on-going aftercare for 3 years after initial assessment, this
aftercare should include:

Cleaning advice and cleaning aids for patients with limited dexterity

Battery removal devices for those with limited dexterity

Replacement of batteries, tips, domes, wax filters and tubing, where required

Update the Patient’s Battery Book with date and number of hearing aid batteries
supplied. For efficiency the Provider should investigate high battery usage/supply.

Replacement or modification of ear moulds

Repair or replacement of faulty hearing aids on a like for like basis

Provision of information (in a suitable language and format) about wider support
services for hearing loss
Ideally patients should be able to access aftercare via walk-in wherever possible; however,
patients must be able to access aftercare services (via face to face or non face to face
methods) within 3 working days of the request. A postal repair service should also be
available to patients for returns within 7 working days.
Aftercare may be provided by any member of staff who is suitably trained and qualified for
the task at hand.
Batteries for hearing aids provided through the service to NHS patients, should be provided
free of charge, regardless of which provider fitted the hearing aid.
3.2.9
Domiciliary Visits
The Provider will establish a domiciliary service for patients who meet the agreed ‘Home
Visit Criteria’ (see Appendix 2) within tariff. This is to include visits to nursing and
residential care homes for routine maintenance. The provider will also develop a strategy
for treating those patients who are house bound.
3.2.10 Care Pathway
Direct access referrals from GPs should only be accepted in line with British Academy of
Audiology Guidelines for Referral to Audiology of Adults with Hearing Difficulty (2015) and
British Society of Hearing Aid Audiologists Protocol and Criteria for Referral for Medical or
other Specialist Opinion (2011).
2017-18 Extended Specification V14
Non-routine auditory
symptoms?
YES
Refer to West
Hampshire
Community
ENT service
for initial
assessment
or
Co-existing or confounding
condition?
YES
or
Previous poor outcome
following AQP Audiology
treatment?
YES
If all three factors
‘No’ then
Offer patient choice
of LQP and
Refer to West
Hampshire LQP
Hearing Aid Provider
This is reflected in the Primary Care Referrals Guidance – as per Appendix 3.
3.2.11 Onward Referral to ENT
Patients should be onward-referred to the West Hampshire Community ENT Service, or
clinical opinion sought and documented before proceeding where patients present with,
non-routine auditory symptoms such as:
 Fluctuating hearing loss not attributable to head cold/respiratory tract infection
 Asymmetrical or single-sided hearing loss
 Sudden or Rapid hearing loss which is a loss that occurred within the preceding 7 days
before the consultation took place
 Significant oversensitivity to everyday sounds
 Troublesome tinnitus, associated with sleep disturbance or symptoms of anxiety or
depression
 Hearing loss syndromes e.g. Usher’s syndrome
 Suspected Non-Organic hearing loss
 Perforation of eardrum
3.2.12 Co-existing or Confounding Conditions – ‘Complexity Criteria’:
Patients presenting with comorbidities, such as those below, may cause added complexity
to the service provision. Such patients may qualify the provider for an enhanced tariff
determined on a patient by patient basis.
 Neurological disorder e.g. stroke or head injuries
 Significant visual impairment not corrected by spectacles
 Physical impairments that are likely to impact on, or prevent use of hearing aids
 Learning disabilities
 Moderate Dementia or diagnosed significant memory problems
 Psychological / Psychiatric Disorders / Psychosocial issues
3.2.13 Enhanced tariff criteria
Any enhanced tariff will be payable where the patient’s care needs is such that substantial
extra time is required for assessment, fitting and follow-up due to challenging behaviour,
2017-18 Extended Specification V14
special needs or complexity of device settings.
The enhanced tariff is not applicable to audiological complexity and is only applicable when
the ‘complexity criteria’ is met (as above) and the detail of which complexity criteria was
applicable is documented in patient history.
3.2.14 Accountability and Governance
Providers need to ensure clear and formal accountability processes and structures are in
place to ensure a safe, effective and integrated continuity of clinical care for all patients.
Providers should have processes in place to ensure appropriate training, qualification and
experience of staff to meet the anticipated needs of the patient population.
The Adult Hearing Service may be provided to any adult patient as long as they do not
meet the contra-indications at Appendix 4.
Patients found to be presenting with any contra-indication should be referred to the West
Hampshire Community ENT Service or advice sought from same.
3.2.15 Staff Qualifications and Training
The suggested minimum Qualification and Skills of Clinical Staff is set out in Appendix 1.
The Provider should have within their local workforce:

A Professional Health of Service (PHoS) who oversees policy, supervision and
training of staff delivering the local service. The PHoS will be named and known to
the area they cover. They will also be a key contact for Commissioners and the
West Hampshire Community ENT Services.

Audiologists who may be based in Provider Service Hubs and provide a peripatetic
service to smaller branches and venues. A qualified audiologist should always
undertake hearing assessments and complex device fitting.

Registered Hearing Aid Dispensers who can undertake fitting and aftercare
independently but who receives leadership and supervision of a named Audiologist
on a regular basis.

Hearing aid technicians who can provide day to day maintenance support within a
branch. They should have a working knowledge of devices and can provider
education and support advice to patients registered within the branch/venue.
3.2.16 Onward Referrals
For patients with more complex needs (beyond the scope and clinical capabilities of the
service) then onward referral to the Community ENT service will be completed.
On returning to the service following assessment and provision of an IMP from the
Community ENT Service, this will be recorded as a follow-up for the patient and not a
further first attendance. The appropriate 3 year pathway tariff should be claimed. Where
the patient does not return to the service within 90 days. This should be recorded as an
‘assessment only’ attendance and tariff.
The Service is required to ensure that they are fully compliant with the NHS e-referrals
system ensuring that any appointments made into the service are made electronically and
patients can be directly booked into a time slot.
The Service is required to ensure that they are fully compliant with the NHS IG Toolkit and
N3 secure connectivity to send and receive patient level data when necessary. Patient
confidentiality and data protection must be paramount at all times.
For onward referral the service is required to ensure they have the capability to utilise the
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‘any to any’ referral service when it becomes available within the NHS e-Referrals Service
that will enable patients to have choice in onward referral where required.
3.2.17 Loss or damage of aids
The provider will repair or replace aids which have been lost or damaged by the patient. If a
patient is thought to be wilfully damaging 2 aids in a year then the provider will raise a
concern and discuss with the patients’ GP and agree an appropriate action plan.
Reoccurrence of wilful damage should be discussed with the lead commissioner to agree
appropriate action plan.
3.3 Population covered
This service is available to all adult patients, with hearing loss, registered with a West
Hampshire CCG GP Practice.
3.4 Any acceptance and exclusion criteria and thresholds
3.4.1 The Provider is directed to Appendix 3 and 4 for referral to service indications
and contra-indications.
This service is for adult hearing loss only and does not cover pediatric needs, patients
should be aged 16 years or over. It is recognised that some Providers may only be able to
take patients over the age of 18 years due to registration and indemnity arrangements and
this should be noted within the Contract with the Commissioner.
3.4.2 Exclusions from provision of Service
The following groups may be excluded from provision of service:
3.5

Abusive, violent or threatening patients without a security escort

Patients barred from NHS Services

Patients requiring general anaesthetic

Patients who have contra-indication to the diagnostic intervention

Patients who are medically unfit to undergo the diagnostic intervention or transfer to
facility

Children under 16 years

As described in 3.2.16 regarding loss or damage of aids, should there be evidence
of willful damage individual patient agreements will need to be developed regarding
their ongoing access to the service.
Interdependence with other services/providers
The West Hampshire Ear, Nose and Throat pathway is captured below:
2017-18 Extended Specification V14
GP Appointment
(Hear Checker)
Routine
ENT
Uncertain
ENT
Routine
Hearing Aid
Service
Hearing
Aid Service
Community
ENT Service
Complex
ENT
Acute Hospital
ENT Service
3.5.1 The Service is an integral element within the West Hampshire Ear, Nose and Throat
pathway and must ensure effective relationships with all other services within the pathway
including but not limited to:

Directly bookable appointment slots

‘Any to Any’ onward referral systems

Information sharing protocols

Agreed referral forms and minimum set of information transfer

Established quarterly pathway review meetings to review current practice and any
areas for improvement.
3.5.2 The Service should be seen as part of a system wide integrated hearing services
working in partnership with:

GPs,

Primary Health Care Teams,

Community Ear Nose and Throat (ENT)

Other hearing aid service providers,

Secondary care Audiology and ENT departments,

Local authorities,

The voluntary & community sector

Independent health care providers
The provider should be able to demonstrate how they work collaboratively with other
organisations to support patients to successfully manage their hearing loss and promote
independent living.
3.5.3 Health Economy Workforce Training and Development Opportunities
2017-18 Extended Specification V14
It is anticipated that the Provider will be a key provider of training placements for audiologist
in training and will work with NHS Health Education England (HEE) and Local Education
and Training Boards (LETBs) that are responsible for the training and education of NHS
staff, both clinical and non-clinical, within their area. LETBs, which will be committees of
HEE, are made up of representatives from local providers of NHS services and cover the
whole of England.
4.
Applicable Service Standards
4.1
Applicable national standards (e.g. NICE)

4.2
Where applicable or become applicable during the life of the Contract.
Applicable standards set out in Guidance and/or issued by a competent body
(e.g. Royal Colleges)

Transforming Adult Hearing Services for Patients with Hearing Difficulty – A Good
Practice Guide’, Department of Health, (2007)

‘Provision of services for adults with tinnitus: a good practice guide’ Department of
Health (2009)

‘Provision of adult balance services: a good practice guide,’ Department of Health
(2009)

‘Common principles of rehabilitation for adults with hearing – and/or balance-related
problems in routine audiology services,’ British Society of Audiology (2012)

‘Shaping the Future: Strengthening the evidence to transform audiology services.’
NHS Improvement Agency (2010)

Action Plan on Hearing Loss (2015).

Regulated activities are listed in Schedule 1 of the Health and Social Care Act 2008
(Regulated Activities) Regulations 2012. All AQP services and outlets should be
registered with the Care Quality Commission (CQC)
http://www.cqc.org.uk/sites/default/files/documents/20130717_100001_v5_0_scope
_of_registration_guidance.pdf
4.3
Applicable local standards
Agreement to this specification places on the Provider an obligation to provide the specified
service at the level of service, days and hours of operation and at the locations specified.
Any variation can be made only with the agreement of the Commissioner. The Provider
must plan for and put in place robust contingency arrangements for known or possible
events which may include:

Staff sickness;

Staff turnover;

Maternity;

Annual leave or other types of special leave.
The Provider may only suspend or restrict service for more than 1 day after agreement with
the Commissioner. Agreement to suspension or restriction will be for a period of no greater
than 21 days from the application to the Commissioner, but may be renewed.
Whilst unexpected staff absence cover over the first twenty-four hours will be challenging to
cover, the provider must ensure that any absence which is in excess of twenty-four hours in
2017-18 Extended Specification V14
duration will be robustly covered such that the usual level of service commissioned
resumes without delay. The arrangements to cover the staff absence will be communicated
effectively to practices affected and to the commissioners.
Agreement and renewal will only take place if the Provider has demonstrated that they have
made reasonable but unsuccessful efforts to substitute staff and resources from other
areas of their operation, or failing that, by obtaining staff and resources from a third party. In
an emergency, the Provider may unilaterally suspend or restrict the service for only 24
hours.
The provider must at all times comply with ‘Code of Practice For The Promotion of NHSFunded Services’ and must ensure that the commissioning body has signed off any
marketing materials before these are used or launched.
Use of the phrase ‘NHS services provided here’ is the preferred advertising mechanism.
4.3.1 General Access and operational times
The service should be available at convenient times for most patients. The service should
be available from 09:00 – 17:00 Monday to Friday with some provision for service in the
local area of appointment before 09:00 and after 17:00. Some additional provision should
routinely be available on Saturdays and Sundays to meet patient demand.
All premises must have appropriate sound proof rooms to undertake hearing assessments.
All premises must accessible for people with disabilities and wheelchair users.
4.3.3 Private Hearing Aids
Where an NHS-qualified provider also provides private hearing aids and a patient
expresses a personal preference for hearing aids that cannot be met by the NHS funded
service, or enquires about privately prescribed hearing aids, providers must advise the
patient that the appointment is exclusively for NHS services and any further dialogue
or information concerning private hearing aids must be dealt with at a separate patient
booked appointment outside of the NHS-funded service.

Providers must not promote their own private treatment service, or an organisation in
which they have a commercial interest.

Providers must not encourage patients to ‘trade up’ (i.e. to privately purchase hearing
devices)

Where an enquiry is made because the patient is experiencing functional difficulty with
an NHS provided device, every effort must be made to address this from within the
NHS funded service. Where this is not possible, the Commissioner must be informed.

Where an enquiry is made because the patient unhappy with their experience with
another NHS provider, every effort must be made to encourage the patient to address
this with that provider. The patient can seek support from Commissioners in resolving
issues. Where this is not possible, the Commissioner must be informed.

Providers should issue patients with a maximum of 1 hearing aid for unilateral use or 2
hearing aids for bilateral use. Spare hearing aids are not part of standard NHS
provision.

For patients requiring assessment only (i.e. no fitting of hearing aids), following a
referral from a GP or ENT clinician, a specific tariff applies (see Appendix 5).
4.3.2 General Principles of agreement and conduct
All service provision must be delivered in accordance with the core values and principles of
2017-18 Extended Specification V14
the NHS and in support of the NHS Constitution.
The Commissioner anticipates a high degree of device manufacturer commonality. Patient
choice of provider should be a priority; however, transfer between providers should not
routinely mean the patient will change device. Patients should not be accepted if existing
functional devices, less than 3 years old, cannot be supported.
Patient transferring from another provider will be assessed with a view to ensuring accurate
and up to date notes in the patient records and ensuring the patient knows what they need
to do to get batteries or repairs.
Patients will be recorded as ‘Provider Transfer’ and the applicable transfer and annual
aftercare tariff will be claimable.
Once accepted the patient will become registered with that chosen provider for a minimum
of 3 years.
Patients will be able to access support from any branch within the provider group or
franchise.
Patients will not be counselled or eligible for a new hearing device(s) unless there is a
clinical need or their current device is more than 3 years old. Any such practice by an agent
of the provider reported to the CCG will trigger an investigation and may incur financial
penalty.
If as a result of the assessment or later reassessment the patient requires a new aid on
clinical grounds, then the Provider will fit the aid(s) and charge the CCG according to the
tariff structure.
Fitting of new aids within a 3 year period will be subject to monthly monitoring and may be
subject to sample audit including patient experience feedback.
The Provider will be a key partner in the local health economy, identifying opportunities for
service improvements and efficiencies as well as working with appropriate governance
arrangements and to protocols agreed and integrated with local specialist providers.
As a key partner in the local health economy the Provider is expected to ensure that all
local resources are used efficiently.
4.3.3 Issues that cannot be resolved and new hearing aids are required
Should any of the incidents listed below occur, then the Provider should start a new
pathway with the patient, assess, fit and provider aftercare for new hearing aids
accordingly.

The aid/s is/are lost and requires replacement.

The aid/s is/are out of guarantee and cannot be repaired or is damaged beyond
repair.

The aid/s is/are no longer usable due to patient damage and require replacement
(subject to maximum of two replacements in 3 year period).

The hearing aid/s no longer meets the needs of the patient’s clinical hearing loss.
4.3.4 Communications
The commissioned pathway is through referral from the patients GP or from The West
Hampshire Community ENT Service. When a new patient is registered with the Provider
following such a referral, a letter of acknowledgement and outcome of the assessment
appointment should be sent to the referrer and copied to the GP if the GP did not make the
2017-18 Extended Specification V14
initial referral.
All Provider promotional material must be approved by the commissioner before use or
distribution as a requirement of the Contract.
All promotional or informational material must responsibly represent NHS Services i.e. that
services and devices are funded through the NHS and not ‘free’.
The Provider will support independent patient enquires about services by directing them to
seek an appointment with their GP to discuss necessary care and options, as per the
commissioned pathway.
The Provider or Provider agents/staff should not develop local forms or letters requesting or
suggesting the GP refer to the service. It is a core requirement that the Provider follows the
commissioned pathway and only accepts referrals from agreed referrers.
The Provider should look to use and promote use of the West Hampshire Primary Care
Referral Form.
The Provider should work with and agree appropriate referral mechanisms and forms
between themselves and West Hampshire Community ENT Service.
4.3.5 System Resilience
It is expected that periods of expected high demand which could lead to the variation,
suspension or restriction of the service provided shall be planned for accordingly. For
example, this may include winter pressure planning. The provider will be expected to
actively contribute toward the commissioner led System Resilience Plan.
4.4 Activity and Reporting
All activity being received and generated by the service provider will be recorded as part of
the Minimum Data Set as set out in this service specification. The MDS submission is
required to validate and support the Provider’s invoicing arrangements.
4.4.1 The MDS does not exclude any initiatives or additional reporting agreed between the
Provider and Commissioner.
4.4.2 The Commissioner may request additional quality performance and activity
information with a reasonable notice period of 90 days.
4.4.3 Activity and MDS will be monitored monthly at Contract and Performance Monitoring
Meetings.
4.4.4 The Provider will submit the MDS and information as required by the contract
including submission to ‘SUS’ – Secondary User Statistics and Unify as required to
demonstrate performance.
The Provider will provided summary reports showing:
Quantative Reports

Referrals received by GP Practice

Referrals received by Community Service

Referrals/Transfers from other providers

Referrals rejected, demonstrating referring practice and reasons for rejection

Waiting times by venue

DNA rates by venue

Cancellation rates (patient or provider) by venue
2017-18 Extended Specification V14

‘See and Fit’ completion rates by venue

New Assessment outcomes (Monaural pathway, Binaural pathway, Transfer
assessment, Assessment

Aftercare activity
Qualitative Reports:

Patient satisfaction with service – by venue

Refer satisfaction with service – by venue

Breakdown of incidents and complaints, resulting actions and learning by venue
This list is not exhaustive and will be further developed in collaboration with the Provider.
4.5 Contract Management
There will be Monthly performance management meetings with the host commissioner and
their representatives at which the clinical and managerial leads will be present. A
standardised performance report will form the basis of discussions at these meetings.
These may be conducted by teleconference, videoconferencing or Skype but should occur
face to face at least quarterly.
The Provider will contribute to the agenda and agree regular standing items for discussion.
This does not preclude discussions and reporting as required (via phone, email or in
person), if deemed relevant, necessary and timely.
The Commissioner should be informed of and in agreement with any Provider to Provider
agreements or sub-contracting arrangements in relation to delivery of the required service.
A schedule of provider premises and venues will be kept up to date within the Contract and
reviewed at least on an annual basis.
4.6 Equality and Diversity
The values and principles that underpin this service specification are detailed below and it
is expected that the provider makes special provision to make their staff aware of the
principles and also demonstrate this in their application and service delivery (proven by
performance data and audit):
 Equal access to the service will be provided for all people who meet the service criteria
and the service will be able to demonstrate this with monitoring information about race,
disability, age, gender, sexual orientation and religion or belief.
 Patients will not be excluded on the grounds of race, disability or gender in line with;
Race Relation (Amendment) Act 2000; Disability Discrimination Duty 2005; Equality Act
2006 (Gender Duty).
 The service will not engage in any discriminatory practices. This includes dealings with
the general public and recruitment of staff.
 All staff have a responsibility to work in partnership with secondary and community
providers to develop, improve and deliver the service.
 Patients will be empowered to exercise their rights to choose and will be given sufficient
information which enables them to make informed decisions about their future long term
care arrangements.
 Patients are to be treated with dignity, respect and as individuals; these will be given high
priority at all points of service delivery. This is a key priority for the NHS measured by the
Care Quality Commission.
2017-18 Extended Specification V14
 The service provider will ensure that patient views are incorporated into development of
future services.
 There will be effective communication and information sharing between agencies
involved in the provision of care and with service users and their carers.
 Information and records will be kept confidential and in accordance with the data
protection legislation and Caldicott principles. Record keeping, information and
confidentiality policies which follow NHS standards must be available and adhered to by
all staff.
 The staff will be appropriately trained to care for service users and will have a clear
understanding of the specific challenges that patients with this disease can experience.
 The service will strive for continuous improvement and provide evidence of progress in
line with their contract performance monitoring arrangements.
 A local process should be agreed and recorded, to address the major service
characteristics that exacerbate existing inequalities.
4.6 Information Management and Technology (IM&T)
N3 connectivity is required in order to ensure the service is delivered on NHS e-Referral
Service.
NHS.net email compliance will be required for transfer of patient identified information.
The Service will ensure that key staff are competent and confident in using local service
technologies and systems so that this does not affect the quality of the service provided to
the patient.
4.7 Quality, Risk and Governance
The provider must ensure that they have a strong ethical position on governance, and clear
guidance from a principal professional with appropriate experience and specialty
knowledge to ensure services are safe, efficient, and reliable and meet national standards.
The provider must be able to explain who provides clinical leadership and to demonstrate
that they have appropriate clinical governance processes in place. Processes should
include methods to report on and learn from serious incidents requiring investigation
(SIRI’s), Health and Safety issues and other service issues that put staff and/or patients at
risk.
The team will also participate in case reviews, regular supervision and appraisal with their
manager and an agreed audit programme for the service.
It is the provider’s responsibility to ensure that all incidents reportable to The National
Patient Safety Agency (NPSA) are documented and notified to the Commissioner with any
planned remedial action.
It is the responsibility of the provider to ensure they have systems to collect and report on
the above measures.
4.7.1 Infection control
Suitable infection control procedures are required. The service should detail the key
infection prevention and control issues relevant to the service. This should include
decontamination issues, audits (e.g. hand hygiene) and reporting of infections.
4.7.2 Complaints
The Provider and agents/staff will comply with National Complaints Legislation and will
have a process for monitoring compliance against response time standards, trends
2017-18 Extended Specification V14
analysis, investigation and learning from complaints. The service will report complaints by
number, trend and learning quarterly to the commissioner.
The Provider will nominate key corporate leads to collaborate with the Commissioner on
investigations of complaints.
4.7.3 Patient Safety Incidents
The Service will have a robust process for managing all patient safety incidents. This
process will ensure that action is taken as a result of the incidents occurring and the
incident reporting process and those services are continuously improved as a result of the
process. The service will report incidents (by number, trend and lessons learned) quarterly
to the commissioner.
4.7.4 Serious Incidents Requiring Investigation
The service will comply with the Commissioner’s SIRI policy. The service will report any
SIRIs to the commissioner within 24 hrs and will provide a copy of the final investigation
report and action plan within 45 days (Grade 1 SIRI) and 60 days (Grade 2 SIRI) (reference
to the overarching SUI schedule of the main Care Services Contract).
4.7.5 Clinical Audit
The Provider will have robust processes for Clinical Audit. The service will develop an
annual clinical audit plan in partnership with the Commissioner and will demonstrate
implementation of actions arising from clinical audit.
The Provider will supply to the commissioner an annual audit plan and examples of
implementation of practice changes as appropriate.
4.7.6 Best Practice Standards
The service will identify the best practice standards that relate to the service. e.g. NICE,
Royal College/Professional Body guidelines, NSFs, National Confidential Enquires etc
4.7.7 Policies and Protocols
The Providers are expected to have and be able to demonstrate compliance with policies &
protocols in the following areas:

Complaints and compensation

Confidentiality

Employee induction training and development

Equal Opportunities

Health & Safety

Freedom of information

Data protection

Race equality

Employee rotas and management support

Protection of vulnerable adulta – to reflect Care Act 2014

Protection of vulnerable children – to reflect Care Act 2014
4.7.8 Information for monitoring
2017-18 Extended Specification V14
The providers will be expected to utilise information systems and to use such systems that
enable information to be shared across the relevant health and social care organisations.
Parties acknowledge that in order for the parties to achieve accurate forecasting, activity
monitoring and prompt and accurate payment, there needs to be timely regular exchange of
detailed and accurate information and accordingly the Provider shall:

comply with current NHS data standards in relation to the information collected and
provided on the services provided.

submit to the Commissioner all reasonable information required by the
Commissioner within an agreed timely fashion.
4.7.9 Confidential Information and Data Protection
Any information of a confidential nature acquired by any individual involved in providing the
service shall not, whether during or after an appointment, be disclosed or allowed to be
disclosed to any person (except on a confidential basis to their professional advisers)
except as may be required by law.
4.8
Service User Experience
As a minimum this will include:

A patient and carer experience survey offered to all patients on follow-up and results
reported on data collected continuously (i.e. quarterly report).

Shared learning from patient experience measures and develop action plans to
address the top three patient concerns with updates every 6 months
4.8.1 Service Users & Carers Experience Local Improvement Plan
A local process should be agreed and recorded, to ensure improvements in areas of
concern.
4.8.2 Reducing Barriers
A local process should be agreed and recorded to ensure the ongoing responsiveness of
services to population groups experiencing health inequalities (e.g Housebound or Traveller
communities).
4.8.3 Improving Quality In Physiological Services (IQIPS)
The Improving Quality in Physiological Services programme (IQIPS) is a professionally-led
accreditation programme encompassing a quality improvement pathway, followed by
accreditation. IQIPS is formed on a set of standards developed by professional groups.
Accreditation is awarded by United Kingdom Accreditation Service (UKAS).
http://www.rcplondon.ac.uk/projects/iqips.
The Commissioner desires that all locally qualified providers will be accredited by UKAS or
can demonstrate commitment to achieving the Standards within an period to be agreed with
Commissioners.
5.
Applicable quality requirements
5.1
Applicable Quality Requirements (See Schedule 4 Parts [A-D])
Providers will demonstrate performance against all quality requirements.
Providers will present a quarterly report on patient feedback, detailing all the feedback and
2017-18 Extended Specification V14
complaints received and actions taken to demonstrate continual service improvement.
The provider must also provide an annual report to commissioners highlighting any results
of research conducted and information gathering which will lead to improvements in
practice and/or efficiencies in service delivery.
The provider is encouraged to participate and present any clinical research supporting the
further development of this service and improvements for patient care.
5.2
Applicable CQUIN goals (See Schedule 4 Part [E])
N/A
6.
Provider Premises
Hearing assessments should be conducted in appropriately sound-proofed rooms, such
that ambient noise levels are compliant with the ‘BS EN ISO 8253-1:1998 standard,
Acoustics- Audiometric Test Methods – Part 1: basic pure tone air and bone conduction
threshold audiometry’. If this is not possible (care home or domiciliary visits, community
premises etc.) the 35dBA standard should be achieved before and during the testing. This
should be done in situ with a portable sound level meter and the evidence of this
undertaking documented.
The premises must be kept clean and safe for use; the premises must also portray an
image of high quality and professional services at all times.
The Commissioner reserves the right to visit premises unannounced and to request site
visits by arrangement.
It is a requirement that all providers have a fully operational NHS N3 (Secure) connection
and will be required to utilise appropriate NHS IT systems such as NHS Mail, NHS SUS,
Choose and Book (soon to be e-Referrals) etc.
2017-18 Extended Specification V14
Appendix 1
Suggested Minimum Qualification and Skills of Clinical Staff
Professional Head of Service (Regionally based)
They should have as a minimum the following qualifications, skills and experience
(or equivalent):

BSc Audiology (or equivalent e.g. Hearing Aid Council Examination or
Foundation Degree in Audiology) level of expertise in audiology with a Certificate
of Audiological Competence (or equivalent);

Registered with the Health Professional Council (HPC) as a Clinical Scientist in
Audiology or registered with the Registration Council for Clinical Physiologists
(RCCP) voluntary register as an Audiologist.

Where the Government’s Modernising Scientific Careers (MSC) programme
brings about changes to registration requirements, senior audiologists must be
registered accordingly;

Appropriate training, skills and experience in testing, assessing, prescribing,
fitting digital hearing aids and providing aftercare.

Appropriate training, skills and experience in clinical supervision, training and
assessment of skills in junior staff.

Relevant experience at a senior management level, including experience of team
in adult audiology and evidence in continued professional development (CPD)
including the provision of patient education related to hearing loss and hearing
aids.
Audiologists (Locally based or peripatetic)
They should have as a minimum the following qualifications, skills and experience
(or equivalent):

BSc Audiology of Post Graduate Diploma in Audiology or (pre 20040 Medical
Physics Physiological Measurement (MPPM)

B-TEC and British Association of Audiological Technicians (BAAT) parts I
and II, with training in Clinical Certificate of Competency;

Registered with the HPC as a Clinical Scientist in Audiology or a Registered
Hearing Aid Dispenser, or with the RCCP Voluntary register.

Where the Government’s Modernising Scientific Careers (MSC) programme
brings about changes to registration requirements, audiologists must be
registered accordingly;

Evidence of appropriate and recognised training (including CPD) to conduct
hearing assessments and rehabilitation, including the provision of patient
education related to hearing loss and hearing aids;

Appropriate training, skills and experience in objective measurements (e.g.
REM) of digital signal processing (DSP) hearing aids.

Evidence of regular clinical supervision with the PHoS.
2017-18 Extended Specification V14
Registered Hearing Aid Dispensers (Locally based or peripatetic)
They should have as a minimum the following qualifications, skills and experience
(or equivalent):

Hearing Aid Council qualification or Foundation Degree in Hearing Aid
Audiology;

Registered with the HPC as a Hearing Aid Dispenser
Assistant/Associate Audiologists (Locally based or peripatetic)
They should as a minimum be trained to perform the function for which they are
employed. Such training may be provided or certified by British Academy of
Audiology (BAA) accredited training centres or national training courses for assistant
audiologists or specific topics such as BSA course in otoscopy and impressions
taking or audiometry.
Associate Audiologists would be expected to be undertaking or have completed the
Foundation Degree in Hearing Aid Audiology (or equivalent) and to undertake
regular supervision with a senior.
Hearing Aid Technician (Locally based within each branch/full time venue)
They should as a minimum be trained to perform the function for which they are
employed. They should have:

Numeracy and literacy skills

Computer skills

Communication skills

Good working knowledge of the devices offered by the Provider

Sound knowledge of the Providers processes and the commissioned pathway

Been internally signed-off as competent to independently:
o changing batteries and tubing
o demonstrate simple adjustments to devices (which the patient could do
themselves)
o appropriate clean a device

Confidence to provide patients with information and sign-post to other
services appropriately.
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Appendix 2
Criteria for Domiciliary Care
Note: Domiciliary Care should meet the same performance criteria as regular
service provision.
Definition of Housebound
“A housebound patient is one who is unable to leave home without exceptional effort
and support and to whom a GP would normally offer home visits as the only practical
means of enabling the patient to consult a general practitioner or other healthcare
professional, face-to-face.
A patient is not housebound if she or he is able to leave their home environment with
minimal assistance and routinely undertakes unassisted visits or visits minimally assisted
by family, friends or other helpers to the doctor, dentist, clinic, hairdresser, supermarket,
bingo, luncheon or similar clubs and activities or other leisure venues. "
Draft trigger questions:1) Where do you normally see your GP?
2) Are you able to get out to the shop’s, lunch club, hairdresser etc?
3) When you go out can you get out on your own or do you need some assistance?
Default position:- if a patient can get out they need to attend the local branch or community clinic.
Shared Care model with Locally Qualified Hearing Aid and Audiology Services
If a high level of Audiological Care is required, or the level of assistance required by the
patient to get out that would mean that a patient could not attend appointments, then
the provider should offer a domiciliary support.
Change of Patient Status
If a patient is acutely unwell and becomes completely housebound, the Provider will
provide care and support the patient needs in or to the home until the patient recovers
their ability to get to the branch. The patient would then be expected to return to visiting
the branch.
Non-urgent Patient Transport Services
Patient who meets the criteria of Non-Emergency Patient Transport Service (NEPTS) for
hospital care would be entitle to this to attend necessary assessment visits and aftercare.
NEPTS is provided by South Central Ambulance Service is designed for the non-urgent,
planned transportation of patients with a medical need for transport.
2017-18 Extended Specification V14
Appendix 3
Primary Care Referral Considerations and pathways for Audiology
Locally qualified providers (LQPs) of Audiology Hearing Aid services are able to provide
assessment and treatment for adult patients with low acuity hearing loss, including ‘age
related hearing loss’.
The flow-chart and table below are designed to help with determining which service is most
appropriate for your patient.
Non-routine auditory
symptoms?
YES
Refer to West
Hampshire
Community
ENT service
for initial
assessment
Co-existing or confounding
condition?
YES
Previous poor outcome
following AQP Audiology
treatment?
YES
If all three factors
‘No’ then
Offer patient choice
of LQP and
Refer to West
Hampshire LQP
Hearing Aid Provider
Non-routine Auditory symptoms:
Co-existing or Confounding Conditions:
 Fluctuating hearing loss not attributable to head
cold/respiratory tract infection
 Neurological disorder e.g. stroke or head injuries
 Asymmetrical or single-sided hearing loss
 Sudden or Rapid hearing loss which is a loss that
occurred within the preceding 7 days before the
consultation took place
 Significant oversensitivity to everyday sounds
 Troublesome tinnitus, associated with sleep
disturbance or symptoms of anxiety or depression
 Hearing loss syndromes e.g. Usher’s syndrome
 Suspected Non-Organic hearing loss
 Perforation of eardrum
 Significant visual impairment not corrected by
spectacles
 Physical impairments that are likely to impact on, or
prevent use of hearing aids
 Learning disabilities
 Dementia or memory problems
 Psychological / Psychiatric Disorders / Psychosocial
issues
Poor outcomes following routine Audiology
intervention:
 Patients who have received audiology treatment via
AQP pathway but who still have significant hearing
difficulty
British Academy of Audiology 2015*
*Reference: www.baaudiology.org/files/1714/3029/2743/BAA_Guidance_on_Identifying_Cases_of_Non_Routine_Hearing_Loss_in_Adults_April_2015.pdf
2017-18 Extended Specification V14
Appendix 4
Contra-Indicators
This guidance is a co-production of collaborative feedback from the clinical leads of existing adult audiology providers – as at
November 2015. The outline guidance is adapted from the BSHAA/TTSA guidelines for referral for direct access audiology.
Locally Qualified Provider fitting is appropriate where any of the referable conditions have been previously investigated (unless
there is a perceived significant worsening of the condition).
History/Presentation
Refer on To
Advice on interim Hearing
Aid Fitting
Local Audiology opinion for guidance
Persistent pain affecting either ear
(defined as earache lasting more
than 7 days in the past 90 days
before.
West Hampshire
Community ENT Service
Possible with ENT support and
providing the patient is not in pain
now.
Pain may indicate an infection which would need a medical
opinion and possible antibiotics prescribing. Pain with a
conductive element may indicate eustacian tube dysfunction which
the HAD would need to be aware of so a volume control could be
added and the patient advised adjustments may be required if the
loss fluctuates.
History of discharge other than wax
from either ear within the last 90
days
West Hampshire
Community ENT Service
Possible with ENT support and
providing discharge does not cause
temporary conductive loss.
Possible only after minimum of 14
days since discharged stopped AND
examination of the ear by Otoscopy
shows no on-going infection or
abnormality
Discharge may indicate an infection which would need treatment.
If a perforation is present, emphasis needs to be given regarding
hearing aid cleaning and spare tubes and domes provided for
regular changes. For ear moulds, 2 pairs may be provided so one
pair can be worn whilst the others are being disinfected. Current
active discharge may prevent an immediate fitting due to infection
control issues but in the case of chronic discharge, fitting may take
place at a time where the patient feels the discharge is at a lower
level.
Sudden loss or sudden
deterioration of hearing
(sudden=within 1 week)
West Hampshire
Community ENT Service
– as Urgent
May be delayed if hearing loss is
purely conductive.
Referral to local acute, secondary
care service may be indicated for
initial management before hearing aid
fitting
If it is a sudden sensorineural hearing loss, the loss is likely to be
permanent so a hearing aid may be fitted. The sooner a hearing
aid is fitted, the higher the chances the patient has of adapting. If
the loss is purely conductive, surgical intervention may reverse the
loss so a hearing aid may only be fitted after advised by ENT. In
the case of a mixed loss, the hearing aid may be fitted with advice
to the patient that the aid will need a reduction in amplification if
ENT is able to provide surgical intervention to reverse the loss.
Rapid loss or rapid deterioration of
hearing (rapid=90 days or less)
West Hampshire
Community ENT Service
May be delayed if hearing loss is
purely conductive.
Can be immediate BUT must have
If it is a sudden sensorineural hearing loss, the loss is likely to be
permanent so a hearing aid may be fitted. The sooner a hearing
aid is fitted, the higher the chances the patient has of adapting. If
the loss is purely conductive, surgical intervention may reverse the
2017-18 Extended Specification V14
History/Presentation
Refer on To
Advice on interim Hearing
Aid Fitting
Local Audiology opinion for guidance
referral to ENT either way
loss so a hearing aid may only be fitted after advised by ENT. In
the case of a mixed loss, the hearing aid may be fitted with advice
to the patient that the aid will need a reduction in amplification if
ENT is able to provide surgical intervention to reverse the loss.
Fluctuating hearing loss, other than
associated with colds
West Hampshire
Community ENT Service
May be delayed if hearing loss is
purely conductive or if no loss found.
If the loss is purely conductive, surgical intervention may repair the
fluctuation and remove the need for amplification. If there is a
sensorineural loss, the fluctuation may indicate other underlying
conditions which require ENT attention. A hearing aid may be
fitted with a volume control and patient instructions advising that
adjustments may be required.
Unilateral or asymmetrical, or
pulsatile or distressing tinnitus
lasting more than 5 minutes at a
time
West Hampshire
Community ENT Service
Possible with ENT support and if
hearing loss is impacting patient’s life.
May be delayed if unilateral hearing
loss is due to a suspected Acoustic
Neuroma.
If bothersome tinnitus refer to nonroutine service (via C-ENT) for
hearing aids and tinnitus
management as often use a single
device with combined hearing aid and
noise generator
Hearing aids may mask the tinnitus so if tinnitus is also
distressing, may provide some relief. Care needs to be taken that
hearing aid fitting does not prevent the patient from seeking advice
from ENT.
Troublesome, tinnitus which may
lead to sleep disturbance or be
associated with symptoms of
anxiety or depression
GP
Possible with ENT support and if
hearing loss is present and impacting
on patient’s life. Caution with patients
with tinnitus exacerbated by noise.
Amplification needs to be provided
with care to ensure that tinnitus is not
made worse.
Not all hear-care clinicians may be
familiar with the symptoms of anxiety
or depression
Patient may be referred to ENT to investigate possible causes of
tinnitus. TRT or CBT may be more appropriate so the patient may
be referred.
Refer to non-routine service (via GP) for hearing aids and tinnitus
management as often use a single device with combined hearing
aid and noise generator
Abnormal auditory perceptions
(dysacuses)
West Hampshire
Community ENT Service
Possible with ENT support and if
sensori-neural hearing loss is present.
Hearing aids may assist patients with auditory processing
disorders. Care needs to be taken to confirm that the hearing aids
provide benefit to the patient and that they do not make the
patient’s hearing ability worse.
Vertigo – New presentation
GP
Possible with ENT support and if
If loss is present, aids may be fitted taking care to ensure that the
2017-18 Extended Specification V14
History/Presentation
Refer on To
Advice on interim Hearing
Aid Fitting
Local Audiology opinion for guidance
Where vertigo is an existing
confounder
West Hampshire
Community ENT Service
hearing aid fitting does not
exacerbate vertigo.
Fitting of aids by LQP if vertigo
previously investigated by GP/ENT
use of a hearing aid does not make the patient’s vertigo worse.
Normal peripheral hearing but with
abnormal difficulty hearing in noisy
backgrounds
West Hampshire
Community ENT Service
No hearing aid fitting unless advised
by ENT.
Consider refer to diagnostic nonroutine Audiology service via C-ENT
As there is no loss, no aid is fitted.
History/Presentation
Refer on To
Advice on interim Hearing
Aid Fitting
Local Audiology opinion for guidance
Complete or partial obstruction of
the external auditory canal
preventing proper examination of
the eardrum and/or proper taking of
an aural impression.
Wax management
guidelines are to see
local Pharmacist rather
than send to ENT or GP
For severe cases refer to
West Hampshire
Community ENT Service
No hearing aid fitting until obstruction
removed or advised by ENT.
Unless the health of the ear can be verified, no fitting of a hearing
aid can take place until fully investigated. Any advised recovery
time due to surgical intervention must be adhered to prior to fitting
an aid.
Abnormal appearance of the outer
ear and/or the eardrum (e.g.,
inflammation of the external
auditory canal, perforated eardrum,
active discharge).
West Hampshire
Community ENT Service
Possible with ENT support and if
hearing loss is present and impacting
on patient’s life and the fitting of a
hearing aid would not cause further
complications.
Perforations may cause a conductive hearing loss. In the case of a
pure conductive loss, no aid would be fitted and the patient
referred to ENT. In the case of a mixed loss, the aid can be fitted
and the patient advised that adjustments may be required as the
perforation heals. The patient would still be referred to ENT to
investigate perforation. If there is current pain, fitting would not
take place. Active discharge may prevent a fitting due to infection
control issues. Advice would need to be provided to patient
regarding cleaning and spare tubes and domes provided.
Ear Examination
2017-18 Extended Specification V14
Audiometry
History/Presentation
Refer on To
Advice on interim Hearing
Aid Fitting
Local Audiology opinion for guidance
Conductive hearing loss, defined as
25 dB or greater air-bone gap
present at two or more of the
following frequencies: 500, 1000,
2000 or 4000 Hz.
N/A if GP aware or
referral received from
West Hampshire
Community ENT Service
Possible with ENT support and if
sensori-neural hearing loss is also
present and impacting on patient’s
life.
Consider referral to secondary care
ENT service
If the conductive hearing loss has already been investigated and
the patient has been referred to us by ENT then hearing aid fitting
may go ahead.
If the loss is purely conductive, the patient must have been
investigated by ENT first as surgical intervention may assist the
loss. In the case of a mixed loss, a hearing aid may go ahead
providing the patient is still referred to ENT and advised that if
surgical intervention is possible, the aid may require adjustments.
Unilateral or asymmetrical
sensorineural hearing loss, defined
as a difference between the left and
right bone conduction thresholds of
20 dB or greater at two or more of
the following frequencies: 500,
1000, 2000 or 4000 Hz.
N/A if GP aware or
referral received from
West Hampshire
Community ENT Service
Hearing aid fitting may go ahead if
loss is impacting on patient’s life.
Has to have been previously
investigated by GP/ENT due to risk of
acoustic neuroma
Consider referral to secondary care
ENT service
The patient’s full history needs to be taken into account. Where
asymmetrical or unilateral loss is present with asymmetrical or
unilateral tinnitus and vertigo, an acoustic neuroma is suspected
and a referral must be made. Care must be taken to ensure that
the fitting of a hearing aid does not delay referral.
Evidence of deterioration of hearing
by comparison with an audiogram
taken in the last 24 months, defined
as a deterioration of 15 dB or more
in air conduction threshold readings
at two or more of the following
frequencies: 500, 1000, 2000 or
4000 Hz.
N/A if GP aware or
referral received from
West Hampshire
Community ENT Service
Hearing aid fitting may go ahead if
loss is impacting on patient’s life.
Consider referral to secondary care
ENT service
In order to have evidence of deterioration, we must have a copy of
the patient’s previous audiograms. It is likely that the patient has
already had hearing aids fitted. If this is found, the aids would be
adjusted then the patient referred to ENT for investigation.
Neurological disorder.
N/A if GP aware or referral
received from West
Hampshire Community
ENT Service
Hearing aid fitting may go ahead in
conjunction with 3rd party service for
patient support.
The HAD will need to consider if the fitting of a hearing aid is
appropriate. This may be the case where there is adequate
support available for the patient. If this is not the case, then the
patient will need to be advised on how to access other services for
ALDs.
Visual impairment.
N/A if GP aware or referral
received from West
Hearing aid fitting may go ahead in
conjunction with 3rd party service for
The HAD will need to consider if the fitting of a hearing aid is
appropriate. This may be the case where there is adequate
Other
2017-18 Extended Specification V14
Audiometry
History/Presentation
Refer on To
Advice on interim Hearing
Aid Fitting
Local Audiology opinion for guidance
Hampshire Community
ENT Service
patient support.
support available for the patient. If this is not the case, then the
patient will need to be advised on how to access other services for
ALDs.
Physical impairment.
N/A if GP aware or referral
received from West
Hampshire Community
ENT Service
Hearing aid fitting may go ahead
providing carer or 3rd party are
available to maintain hearing aids.
Patient may be directed to a 3rd party
service for additional support.
The HAD will need to consider if the fitting of a hearing aid is
appropriate. This may be the case where there is adequate
support available for the patient. If this is not the case, then the
patient will need to be advised on how to access other services for
ALDs.
Learning disabilities.
N/A if GP aware or referral
received from West
Hampshire Community
ENT Service
Hearing aid fitting may go ahead if
audiometry results are reliable and
carer or 3rd party are available to
maintain hearing aids.
Patient may also be directed to 3rd
party service for additional support or
services.
Where the results are questionable, another test may need to take
place at a later date so a comparison of results may be made.
Additional subjective hearing checks will be required once the aids
are fitted.
The HAD will need to consider if the fitting of a hearing aid is
appropriate. This may be the case where there is adequate
support available for the patient. If this is not the case, then the
patient will need to be advised on how to access other services for
ALDs.
Dementia or memory problems.
N/A if GP aware or referral
received from West
Hampshire Community
ENT Service
Hearing aid fitting may go ahead if
audiometry results are reliable and
carer or 3rd party are available to
maintain hearing aids. Patient support
may also be provided by 3rd party
service.
Where the results are questionable, another test may need to take
place at a later date so a comparison of results may be made.
Additional subjective hearing checks will be required once the aids
are fitted.
The HAD will need to consider if the fitting of a hearing aid is
appropriate. This may be the case where there is adequate
support available for the patient. If this is not the case, then the
patient will need to be advised on how to access other services for
ALDs.
Psychological / psychiatric
disorders / psychological issues.
N/A if GP aware or referral
received from West
Hampshire Community
ENT Service
Hearing aid fitting may go ahead if
audiometry results are reliable and
carer or 3rd party are available to
maintain hearing aids. Patient support
may also be provided by 3rd party
service.
Where the results are questionable, another test may need to take
place at a later date so a comparison of results may be made.
Additional subjective hearing checks will be required once the aids
are fitted.
The HAD will need to consider if the fitting of a hearing aid is
appropriate. This may be the case where there is adequate
support available for the patient. If this is not the case, then the
patient will need to be advised on how to access other services for
2017-18 Extended Specification V14
Audiometry
History/Presentation
Refer on To
Advice on interim Hearing
Aid Fitting
Local Audiology opinion for guidance
ALDs.
Suspected Non-Organic Hearing
Loss
West Hampshire
Community ENT Service
No hearing aid fitting unless advised
by ENT.
The patient will require objective measurements such as ARTs to
confirm presence/absence of loss prior to hearing aid fitting.
Patients who have received
audiology treatment via LQP
pathway but who still have
significant hearing difficulty.
West Hampshire
Community ENT Service
New hearing aid fitting may go ahead
if patient reports significant difference
in benefit.
Care must be exercised to ensure that referable causes of
rehabilitation failure are not missed. The HAD must assess the
cause of the remaining hearing difficulty to ensure that the fitting of
a new aid is appropriate.
2017-18 Extended Specification V14
Appendix 5
Tariff Structure:
Tariff band 1: New patients aged 16/18 and over with routine, no-complex auditory
presentations:

Assessment only
£ 45

Assessment, Monaural fitting and 3 years of aftercare
£265

Assessment, Binaural fitting and 3 years of aftercare
£345

Top-up from Monaural to Binaural fitting and 3 years of aftercare
£ 80

Aftercare – claimable annually from fourth year after registration
£ 21

Replacement Aid
£ 65

Transfer from another provider and aftercare only – First year
£ 66
o
Subsequent years until clinically necessary to issue new device/s £ 21
Tariff band 2: New patients aged 16/18 and over with non-routine presentations or
non-audiological needs where the patient meets the following ‘Complexity Criteria’
(see specification):

Learning disabilities which significantly affects behaviour

Moderate to severe dementia which significantly affects behaviour

Psychological / Psychiatric disorders / psychosocial issues which significantly affects
behaviour or instruction compliance:
o
Congenital conditions which make presentation more complex
o
Neurological disorder e.g. stroke or head injuries
o
Significant visual impairment not corrected by spectacles
o
Physical impairments that are likely to impact on, or prevent use of hearing
aids
o
Other consideration by individual application
Enhanced tariff criteria definition
The enhanced tariff will only be payable where the patient’s care needs are such that
substantial extra time is required for assessment, fitting and follow-up due to very
challenging behaviour, special needs or complexity of device settings.
The enhanced tariff is only applicable when the ‘complexity criteria’ is met and the detail of
which complexity criteria was applicable is documented in patient history.
Enhanced tariffs – applicable where ‘Complexity Criteria’ met

Assessment only
£ 65

Assessment, Monaural fitting and 3 year of aftercare
£365

Assessment, Binaural fitting and 3 year of aftercare
£445

Upgrade (top-up) from Monaural to Binaural fitting and 3 year of aftercare £ 80
2017-18 Extended Specification V14

Replacement Aid
£ 95

Annual after care until clinically necessary to issue new device/s
aftercare visits/repairs; caped at 10 claims per patient per year.
£ 15 per
o

NB: this does not mean the patient can only be seen 10 times. Care should
be provided as per the specification.
Transfer from another provider and aftercare only – First year
£ 65 plus
o
Annual after care until clinically necessary to issue new device/s
aftercare visits/repairs; caped at 10 claims per patient per year.
o
NB: this does not mean the patient can only be seen 10 times. Care should
be provided as per the specification.
£ 15 per
Non-standard Hearing-aid Devices
It is anticipated in the vast majority of cases the patients’ needs will be met with a device
available from the NHS Framework range.
It is recognised that in very exceptional cases a very complex or specialised devices may
be required. In these cases where the cost of a device is over £100 more than the tariff
price to the provider, prior approval may be sought for full cost of the device. Without
appropriate prior approval the CCG will not pay above the tariff banding as set out.
Issues that cannot be resolved and new hearing aids are required
Should any of the incidents listed below occur, then the Provider should start a new pathway
with the patient, assess, fit and provider aftercare for new hearing aids accordingly.

The aid/s are lost and require replacement.

The aid/s are out of guarantee and cannot be repaired or are damaged beyond
repair.

The aid/s are no longer usable due to patient damage and require replacement
(subject to maximum of two replacements in 3 year period).

The hearing aid/s no longer meets the needs of the patient’s clinical hearing loss.
2017-18 Extended Specification V14
Locally Qualified Provider:
Adult Audiology Referral
Form 
Patient Details:
NHS no.
Practice Pt. ID
Surname
Forenames
Previous surname
Title
Sex
Date of birth
Address
Home tel. no.
Work tel. no.
Post Code
Mobile no.
Referral Details:
Referring clinician
Usual GP
GP Practice
Practice Code
Practice Address
Reason for
referral
Telephone
Please tick
Locum GP
New
presentation
Hearing Aid
Assessment
Transfer of
existing NHS
hearing aid
patient
If Transferring: Details of previous
provider
Please assess this patient under the Audiology Direct Referral scheme, due to concerns about their hearing.
I confirm this patient:(tick if all bullet points are true; otherwise refer to West Hampshire Community ENT
Service)

Has both ears clear of all wax

Has intact and healthy ear drums

Does not report fluctuating hearing loss, ear pain longer than 7 days or discharge within 90 days

Does not report unilateral hearing loss and/or unilateral or troublesome tinnitus

Does not report sudden onset or rapid deterioration of hearing loss

Does not report suffering with dizziness (vertigo)

No conductive element
This patient is interested in having hearing aids if suitable.
2017-18 Extended Specification V14
Locally Qualified Provider:
Adult Audiology Referral
Form 
HearCheck results – if undertake:
Current Medications:
Enter number of tones heard (0 – 3)
RIGHT
Low tone
High tone
Additional relevant information:
This form should be attached to the NHS E-Referral Service Referral.
This form should be attached to the NHS E-Referral Service Referral.
This Form should be used when Referring to a West Hampshire CCG Locally
Qualified Provider (LQP) Audiology/Hearing Aid Service.
2017-18 Extended Specification V14
LEFT
NHS Funded Hearing Aids
Eligibility Criteria and Thresholds
Appendix 7
Eligibility Criteria for NHS Funded Hearing Aids
NHS Funded hearing aids will be provided by West Hampshire Clinical Commissioning
Group, to adult patients who meet all the following criteria:

Are over 16/18 years of age and registered with a West Hampshire GP Practice.

Are entitled to NHS treatment and services.

Have a hearing need which is correctable with hearing aids.

Are committed to wearing hearing aids and working with the service provider to
optimise the potential benefit i.e. hearing aids need to be worn as advised by the
audiologist or audiology technician.
o NB: Hearing devices enable the brain to adapt to altered sound and usually
need to be worn consistently. Wearing hearing aids intermittently reduces
the potential benefit of the device.

Have a clinical hearing deficit of at least 26dB, mild hearing loss with moderate
functional impairment or occupational hearing requirement.
Eligibility thresholds
The threshold to be eligibility for NHS Funded hearing aids are set out below:
Degree of Hearing loss Audiometric Thresholds (objective measure):
•
Normal hearing (0 to 25 dB HL) – NHS funded devices not routinely supplied
•
Mild hearing loss (26 to 40 dB HL) – NHS funded devices may be supplied where the
individual has mild hearing loss bilaterally and a moderate functional impairment or
occupational requirement
•
Moderate hearing loss (41 to 70 dB HL) – NHS funded devices should be supplied
•
Severe hearing loss (71 to 90 dB HL) – NHS funded devices should be supplied
•
Profound hearing loss (greater than 91 dB HL) – NHS funded devices should be supplied
Exemptions
The following are not included in the eligibility thresholds above:

Hearing loss due to infectious diseases.

Hearing loss in babies, children or teenagers up to 17 years of age or anyone who
has worn hearing aids since childhood – not covered by this service or
specification.

Individuals who already have an NHS hearing aid who have not reached the end of
their 3 year pathway (At this point they will be reassessed)

Patients with a confirmed diagnosis of dementia

Patients with a Learning Disability
2017-18 Extended Specification V14
NHS Funded Hearing Aids
Eligibility Criteria and Thresholds

Patients with auditory processing disorder

Patients with severe multiple sensory disability

Patients with diagnosed tinnitus

Patients with sudden onset hearing loss

Patients with occupational hearing loss
Patient reported functional impairment measure
The Glasgow Hearing Aid Benefit Profile (GHABP) has been developed with the aim of
maintaining clinical suitability and utility whilst providing outcome scales with sufficient
statistical leverage to distinguish between alternative management regimes. This is
achieved by accessing a number of different components of disability and benefit via a
mixture of the perceived disability and benefit in both pre-specified and subject-specified
listening circumstances of relevance to the hearing impaired person.
The GHABP consists of a single sheet of A4 paper printed on both sides. This accesses
four pre-specified listening circumstances which commonly occur in the lives of people
with a degree of hearing-impairment. These are assessed separately for:

their occurrence,

the degree of difficulty experienced by the listener (initial disability),

the effect or impact on the hearing-impaired listener’s life (handicap),

the extent to which the hearing aid is used in that listening circumstance,

the extent to which hearing is improved in that listening circumstance (hearing aid
benefit),

the hearing difficulty experienced by the listener after the fitting of the hearing aid
(residual disability) and

the client’s satisfaction with their hearing aid for that listening circumstance.
See appendix 8.
The shaded portions of the GHABP identify the elements completed at assessment and
prior to management/hearing aid fitting. The unshaded portion is recorded on a separate
occasion after the management measure or device(s) have been fitted.
The second page allows the listener to specify (up to four) additional listening
circumstances of importance and relevance to their everyday communication
circumstances. Only listening circumstances which exist in the listener’s experience
contribute to the scales of initial and residual disability, while only those which lead to a
material disability contribute to handicap, use, benefit and satisfaction.
2017-18 Extended Specification V14
Glasgow Hearing Aid Benefit Profile
(GHABP)
Appendix 8
Glasgow Hearing Aid Benefit Profile
Provider stamp:
Date of assessment
Date of review
Listening to the television with other family or friends when the volume is adjusted to suit other people
How much difficulty do
you have in this
situation?
How much does any
difficulty in this situation
worry, annoy or upset
you?
In this situation, what
proportion of the time do
you wear your hearing
aid?
In this situation, how
much does your hearing
aid help you?
In this situation, with your
hearing aid, how much
difficulty do you now have?
For this situation, how
satisfied are you with your
hearing aid?
0__N/A
1__No difficulty
2__Only slight difficulty
3__Moderate difficulty
4__Great difficulty
5__Cannot manage at all
0__N/A
1__No difficulty
2__Only slight difficulty
3__Moderate difficulty
4__Great difficulty
5__Cannot manage at all
0__N/A
1__No difficulty
2__Only slight difficulty
3__Moderate difficulty
4__Great difficulty
5__Cannot manage at all
0__N/A
1__No difficulty
2__Only slight difficulty
3__Moderate difficulty
4__Great difficulty
5__Cannot manage at all
0__N/A
1__No difficulty
2__Only slight difficulty
3__Moderate difficulty
4__Great difficulty
5__Cannot manage at all
0__N/A
1__No difficulty
2__Only slight difficulty
3__Moderate difficulty
4__Great difficulty
5__Cannot manage at all
Having a conversation with one other person when there is no background noise
How much difficulty do
you have in this
situation?
How much does any
difficulty in this situation
worry, annoy or upset
you?
In this situation, what
proportion of the time do
you wear your hearing
aid?
In this situation, how
much does your hearing
aid help you?
In this situation, with your
hearing aid, how much
difficulty do you now have?
For this situation, how
satisfied are you with your
hearing aid?
0__N/A
1__No difficulty
2__Only slight difficulty
3__Moderate difficulty
4__Great difficulty
5__Cannot manage at all
0__N/A
1__No difficulty
2__Only slight difficulty
3__Moderate difficulty
4__Great difficulty
5__Cannot manage at all
0__N/A
1__No difficulty
2__Only slight difficulty
3__Moderate difficulty
4__Great difficulty
5__Cannot manage at all
0__N/A
1__No difficulty
2__Only slight difficulty
3__Moderate difficulty
4__Great difficulty
5__Cannot manage at all
0__N/A
1__No difficulty
2__Only slight difficulty
3__Moderate difficulty
4__Great difficulty
5__Cannot manage at all
0__N/A
1__No difficulty
2__Only slight difficulty
3__Moderate difficulty
4__Great difficulty
5__Cannot manage at all
Carrying on a conversation in a busy street or shop
How much difficulty do
you have in this
situation?
How much does any
difficulty in this situation
worry, annoy or upset
you?
In this situation, what
proportion of the time do
you wear your hearing
aid?
In this situation, how
much does your hearing
aid help you?
In this situation, with your
hearing aid, how much
difficulty do you now have?
For this situation, how
satisfied are you with your
hearing aid?
0__N/A
1__No difficulty
2__Only slight difficulty
3__Moderate difficulty
4__Great difficulty
5__Cannot manage at all
0__N/A
1__No difficulty
2__Only slight difficulty
3__Moderate difficulty
4__Great difficulty
5__Cannot manage at all
0__N/A
1__No difficulty
2__Only slight difficulty
3__Moderate difficulty
4__Great difficulty
5__Cannot manage at all
0__N/A
1__No difficulty
2__Only slight difficulty
3__Moderate difficulty
4__Great difficulty
5__Cannot manage at all
0__N/A
1__No difficulty
2__Only slight difficulty
3__Moderate difficulty
4__Great difficulty
5__Cannot manage at all
0__N/A
1__No difficulty
2__Only slight difficulty
3__Moderate difficulty
4__Great difficulty
5__Cannot manage at all
Having a conversation with several people in a group
How much difficulty do
you have in this
situation?
How much does any
difficulty in this situation
worry, annoy or upset
you?
In this situation, what
proportion of the time do
you wear your hearing
aid?
In this situation, how
much does your hearing
aid help you?
In this situation, with your
hearing aid, how much
difficulty do you now have?
For this situation, how
satisfied are you with your
hearing aid?
0__N/A
1__No difficulty
2__Only slight difficulty
3__Moderate difficulty
4__Great difficulty
5__Cannot manage at all
0__N/A
1__No difficulty
2__Only slight difficulty
3__Moderate difficulty
4__Great difficulty
5__Cannot manage at all
0__N/A
1__No difficulty
2__Only slight difficulty
3__Moderate difficulty
4__Great difficulty
5__Cannot manage at all
0__N/A
1__No difficulty
2__Only slight difficulty
3__Moderate difficulty
4__Great difficulty
5__Cannot manage at all
0__N/A
1__No difficulty
2__Only slight difficulty
3__Moderate difficulty
4__Great difficulty
5__Cannot manage at all
0__N/A
1__No difficulty
2__Only slight difficulty
3__Moderate difficulty
4__Great difficulty
5__Cannot manage at all
Initial disability
Score
Initial handicap
Score
2017-18 Extended Specification V14
SCHEDULE 4 – QUALITY REQUIREMENTS (PERFORMANCE)
C. Additional Local Quality Requirements
CCG Leads
Quality Requirement
Threshold
Method
Measurement
Monthly or annual
application
of
consequence
Applicable
Specification
CH-T
Patients referred to the service should be
assessed within 16 calendar days of receipt
of referral
90%
Provider collated report
Subject to GC9
Monthly
LQP - Adult Audiology
CH-T
Patients requiring hearing aid fitting should be
seen within 20 working days of the
assessment
90%
Provider collated report
Subject to GC9
Monthly
LQP - Adult Audiology
CH-T
Follow-up appointments should be within 90
days of the fitting
90%
Provider collated report
Subject to GC9
Monthly
LQP - Adult Audiology
CH-T
Patient requested follow-up for maintenance
and minor repairs within 3 working days
98%
Provider collated report
Subject to GC9
Monthly
LQP - Adult Audiology
CH-T
Patient will perceive benefit from being fitted
with a hearing device measured through
repeat GHABP Scores
98%
Provider collated report
Subject to GC9
Monthly
LQP - Adult Audiology
CH-T
Responses received from a representative
patient sample via a service user survey
should report overall satisfaction with the
service as good/very good or excellent
90%
Provider collated report
Subject to GC9
Monthly
LQP - Adult Audiology
90%
Provider collated report
Subject to GC9
Quarterly
LQP - Adult Audiology
Zero (0)
Provider collated report
Subject to GC9
Quarterly
LQP - Adult Audiology
•
CH-T
CH-T
Consequence
breach
of
Service
By Local Venue/Branch
Responses received from referrers to survey
should report overall satisfaction with the
service as good/very good or excellent
•
of
By Local Venue/Branch
Any never event or incidents requiring
investigation should be reported
2017-18 Extended Specification V14
CCG Leads
Quality Requirement
Threshold
Method
Measurement
CH-T
Complaints, resulting actions and learning by
venue
Zero (0)
Provider collated report
CH-T
Electronic Referrals Service (ERS, formerly
Choose and Book):
1.
CCG E-Referrals Report
1.
<5% Appointment
Slot Issues (ASI)
of
All elective / planned care services to be
available on ERS Directory of Services
2017-18 Extended Specification V14
Consequence
breach
Subject to GC9
of
Monthly or annual
application
of
consequence
Applicable
Specification
Quarterly
LQP - Adult Audiology
Quarterly
Service
SCHEDULE XX – INFORMATION AND DATA REQUIREMENTS (PERFORMANCE)
XX. Additional Local Information and Data Requirements
CCG Leads
Information/Data Requirement
Frequency
Format
Consequence
of breach
[Application/Notes]
CH-T
Referrals received by GP Practice
Monthly
Excel
or
other
agreed format
Subject to GC9
• GP Practice Code Identifier
• CCG Identifier
Submitted through
the agreed route to
the
agreed
timeframe
CH-T
Referrals received by Community
Service
Monthly
Excel
or
other
agreed format
Please note that all data collected
and shared will need to be available
in a format which can be split by
demographics,
according
to
monitoring requirements.
Subject to GC9
• GP Practice Code Identifier
• Provider Identifier
• CCG Identifier
Please note that all data collected
and shared will need to be available
in a format which can be split by
demographics,
according
to
monitoring requirements.
CH-T
CH-T
Referrals/Transfers
providers
from
other
Referrals rejected, demonstrating
referring practice and reasons for
Monthly
Monthly
Submitted through
the agreed route to
the
agreed
timeframe
Subject to GC9
Excel
or
other
agreed format
Subject to GC9
2017-18 Extended Specification V14
• GP Practice Code Identifier
• CCG Identifier
Please note that all data collected
and shared will need to be available
in a format which can be split by
demographics,
according
to
monitoring requirements.
• GP Practice Code Identifier
• CCG Identifier
CCG Leads
Information/Data Requirement
Frequency
Format
Consequence
of breach
rejection
CH-T
CH-T
[Application/Notes]
Please note that all data collected
and shared will need to be available
in a format which can be split by
demographics,
according
to
monitoring requirements.
Waiting times by venue
TBC
DNA rates by venue
TBC
Submitted through
the agreed route to
the
agreed
timeframe
Subject to GC9
Excel
or
other
agreed format
Subject to GC9
• GP Practice Code Identifier
• CCG Identifier
Please note that all data collected
and shared will need to be available
in a format which can be split by
demographics,
according
to
monitoring requirements.
• GP Practice Code Identifier
• CCG Identifier
Please note that all data collected
and shared will need to be available
in a format which can be split by
demographics,
according
to
monitoring requirements.
CH-T
TG/SE
Cancellation rates
provider) by venue
(patient
Financial Reconciliation Report
or
TBC
Monthly
Submitted through
the agreed route to
the
agreed
timeframe
• GP Practice Code Identifier
Submitted through
the agreed route to
the
agreed
• GP Practice Code Identifier
2017-18 Extended Specification V14
• CCG Identifier
Please note that all data collected
and shared will need to be available
in a format which can be split by
demographics,
according
to
monitoring requirements.
• CCG Identifier
CCG Leads
Information/Data Requirement
Frequency
Format
timeframe
2017-18 Extended Specification V14
Consequence
of breach
[Application/Notes]
Please note that all data collected
and shared will need to be available
in a format which can be split by
demographics,
according
to
monitoring requirements.
2017-18 Extended Specification V14
2017-18 Extended Specification V14